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5 LEAVITT CT - BUILDING INSPECTION (2) IThe Commonwealth of Massachusetts CITY Board of Building Regulations and Standards OF SALEM Massachusetts State Building Code,780 CMR,7'edition RevisedJanuory Building Permit Application To Con§gqct,Repair,Renovate Or Demolish a 1, 2008 One-or Tw -Fa ily Dwelling This S "on F r Official UsSOnly Building Permit Number: App' �f f Signature: YL/ �O o Building Commissio7UwL�t Date NFORMATION 1.1 Property✓Addfreesss`: / Assessors Map&Parcel Numbers 1.1a Is this an accepted street? p Number Parcel Number 13 Zoning Information: Property Dimensions: Zoning District Propose Area(sq ft) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L a 40,§54) 1.7 Flood Zone lufarmation: 1.8 Sewage Disposal System. .Zone: _ Outside Flood Zone? Municipal❑ On site disposal stem ❑ Public❑ Private❑ Check if yes❑ pO SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record- /4� L:VIVI Name(Print) Address fjo Service: 7 7Ji EGG- 0-567 Signature Teleph SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Bi ld'mg)t Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ NtmmberofUnits__2,_ I Other ❑ Specify: Brief Description of Proposed Worle: f P—U 7i- y1 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I.Building $ 7 7 d ,_ 1. Building Permit Fee:$ Indicate how fee is detemrined: 2.Electrical $ ❑Standard Cityffown Application Fee ❑Total Project Cost'(item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 7.70 1 0 Paid in Full 0 Outstanding Balance Due: lT� SECTION 5: CONSTRUCTION SERVICES 5.11 Liic_ensed Construction Supervisor(CSL) C r, �,�/O 0 ,52V&S /�[ �fOUf/f f License Number F.xpr on to Name of//CSL-Holder List CSI.Type(see below) T Description U Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling at ye e M Mason Only 5�' C ��i RC Residential RoofingCovering eeph6m, - WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 51 Registered om InuirovementContraetor 111C) `� Zp '_ii &!i I'—fw �e , ,etc L' _ Y to H1CC y.Name erHlC N Registration Number j IZZ-.soN�`s(7�az� Alit ©K70 2`2�/>i ddress Qj A,S 3 �'(o Expiration Uate i�anrR dep tn: SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.¢25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application Failure to provide this affidavit will result in the denial of the issuance of the building permit Signed Affidavit Attached? Yes..........)K No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Si of Owner Date SECTION 7b:OWNER OR AUTHORIZED ACENT DECLARATION I, �'1�0/.✓t� yll4V 1 CA.✓f L as Owner or Authorized Agent hereby declare. that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. r f MovI,rvy ("t j 'nt are Lf Signature of Owner or Authorized Agent Date (Signed under the pains and Penalties of NOTES- 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(RIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.115,respectively. 2 When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) _ (including garage,finished basementlardcs,decks or porch) Gross living area(Sq..Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halflbaths Type of heating system Number of decks/porches Type of cooling system _ Enclosed _Open 3_ "Total Project Square Footage"maybe submited for"Total Project Cost" I�'lass:;chtisctrx- Dcp:u'tntcnt Board of Build!",Rc-ulatino Public Sare'ntl. sand Construction Supervisor Specialty Licenses ---.. ._. _ .... _.,..._...__. — nd License or registration valid forindlvidul use ohly License: CS SL 101003 Tlsafore-the-expiration date. 1f found return to: Restrlcted.toc RF,WS •`' Board of Building Regulations and Standards yp: 10ne Ashburton Piece Run 1301 STAVROS"NlOIffSOULA8 (Boston 11 WILSON STREET... . .. /�- l - SALEM, MA 01970 � Expiration: 12/14,10,I o[v without signature f\unmlasiuner . Trft: 101003' i ,�f2e fivi o 11 g egul ions/ tan One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Tmproveme Gentractor Registration Reglstration: 154326 Type: private Corporation Expiration: 2/27/2011 Try 279646 ALPINE PROPERTY SERVICES;fO _,_:._ STARROS MOUTSOULAS 11 WILSON STREET SALEM, MA 01970 Update Address and return card.Mark reason for change. •• Address ❑ Renewal Employment Q Lost Card DPe.CAt 0 e0M-0rarr-PCe490 - Bo of BulidioB eB a86us and Stead Neste License or registration valid for individul use only ; HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Beard of Building Regulations and Standards Registf�pon, 164326 One Ashburton Place Rm 1301 ' Ex i 6om -K :-227Y2011 TrA 279&16 Boston,Mo.02108 `.6: ;privats Corpore0on ALPINE PROPS F ES': 0,INC. STARROS M0 .'s 3'6. 17 WIISON SIRE _�r• ,Y Not valid without signature SALEM,MA 01970 ' Administrator . A•Inss:rchuscttx- Dcp:u'tnlenr of Public Suft•ry' Board of Buildl,g Rervbrtions and Standards Construction Supervisor Specialty Llcense License or registration valid for lndividul use obly License: CS SL 10f003 - •" 1Before-the"expiration date If found return to: Restrlcted,toc RF,WS Board oliBuilding Regulations and Standards t I One Ashburton Place Rus 1301 STAVROS"MIOUTSOULAS iBoston 11 WILSON STREET. SALEM, MA01970 - } Expiration: 17/1 Trg: 101003'4/2011 I Not without signature - I ar an J Boar o � u> i (ion�' °ta� One Ashburton Place - Room 1301 Boston_ Massachusetts 02108 Home Imnrovemea-- ntractor Registration - Re9ishadon: 154326 Type: prka a Corporation Expiration: 2/272011 Tr# 279M ALPINE PROPERTY SERVICES?(tOrT � -r' i STARROS MOUTSOULAS 11 WILSON STREET .: .- SALEM, MA 01970 =' Update Address and return card.Mark reason for change. •• Address ❑ Renewal Employment Lost Card oPS C l A SOM-07107-PCB490 - - o of Binding a Sos and Sm a License or registration valid for lndividul use only Board , IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Regist¢pdrr 154326 One Ashburton Place Rin 1301 ' Ex I tlrj2272011 Tr# 279846 Boston,Ma.02108 ;%&I pdbteCorporation - ALPINE PROPS_ �INC. . STAR IS MO u• it WILSONSTRE _ Not valid without signature SALEM,MA 01970 "- Administrator —. ' ;.•_'i.:a4�1vR�dA�DE"(AMYODIYYYT)• 1COR1D® CERTIFICATE OF LIABILITY INSURANCE 6./.a3/aolo RoDD06R (617)471-1220 FAX: (617)479-5147 THIS CERTIFICATE IS ISSUED AS A MIAITMRJOF•INFOWYIATION 0nity Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON; THE,•C- FICAT.E HOLDER THIS CERTIFICATE DOES NOT•'A�IEND,'•EXTEND OR i00 Victory Rd. ALTER THE COVERAGE AFFORDED BY THel I.IC1ES•BELOW. I-Sq� w say • . ro3wh Quincy MA 02171 INSURERS AFFORDING COVERAGE NAIL S _ rSU� ••• MSURIRA:FiXat Xeronry Ina- •13-0' ' Lipine- Property Services Co., Inc. Usu my-ka=leysvilla Insurance. ?.0. Sox 395 INsvRL3R r.Great Amarican I_nsuranca L39 Boston Street MSURETi D: _ ,_ - -_ •, ropsfie 'd MA 01983 INSIRSi E: OVERAGES THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WDICATEO.•N01WTT4VAN,QINO'; ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIOrATE MAY BE ISS,L�D OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONSAND CONDITIONS OFSUC 1 POLICIES.AGFiREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMSnATE _ •• • — POLICY NUMBER _•• POLICY �� ON •-_ LlhJia -;•^~� GENERALLPam EACH OCCURRENCE • 'b •1 000,000 $ OOMMSRCULG0QFALLUUJNLRY Mee ' .E oy_S 000 A CLAIMS MND6 Fa I OCMkR IMOUL0011363 6/14/20iO 6/14/2011 Y6 Exp ene ' ' S. Rwlude_d T•8 S30L000 Deductible PERSOr31L&ADVMNURY E' ,; }; 00 ODo OENIESJA iGfEGATB' : 2,000,000 GENT.AGGREGATELMITAPPUESPEIL' PRODUCTS-COMWOP"GG E 1-ja0 000 POLIO/ g-1 Pao- LOc AUTDMOBIlE LN&NiY COMBMID 9WBLE lMiT ANYAUT0 IrA, •• 'S ' ' ,1•,000,_000 B ALLOVMSDAUOS SA00000081826S 1/9/2010 1/9/2011 v^OR pyIURY• ,b ' X SMIEDUIEO AUTOS (P� % IfIRWAUTOS BODILY IWURY . I % NOWDWNWAUTOS (Per P DAMAGE s DARARRB LVSIUN AUTOONI.Y-fAAQq0SNr 4 ANYALIM OTHER THAN 'El1•ACC E •_ AUTOONLYI ..qa,G•'s' . IDccCSSIMB1IEiLALMBRDY BACK OCCURRENCE •.' S• •.5.000 coo Y OCCUR CLAIMS MADE AGGREGATE b~Y' '5 600,O00 A DEDUCTIBLE MMOODII73 6/14/2010 6/14/2011 b" -•_ $ RETENTION b lo,oo s ' WORO?RSCW94315ATION IMFAU ••P ANDEMPLDYERSLUBIU ra ' ANY FROFRIETORIPARRDrER1GtECUTNE Y!❑N FI.EACHACM615IT E AIE n . �OFFICEWNBER OW WO6T IMandumM NM S.L.DISEASE-PA RM E -, _....,.. W d�rea PR V45SNE bebv, EL.DISEASE aPAUNIDRR ' CrIO7NERSNLAND NARINB 667004002 ,2/28/2010 2/28/2011 rsns '$5,000 MISCBLLANSOIIS TOOLSD�BcrulcB •S1,000 a RQ4iPNENT DESCRPRONOPOPDMTHMI LWATIONSIVENCLESI FXCLLOONSAOOFA BY EMDORSFMENTISPECIAL PRMODNS ' CERTIFICATE HOLDER CANCELLATION SNOULDANYOFTNGABOVEDESCRBED PWCUM BEC=ELL'.S)LSFFOTZR'1'NEFXPIRLTON DATE TLWREOF,THe ISSUING INSURER WALL ENDEAVOR.7O W?L•T �ATa Y17UfTEN . NOTICE TOTR@CErmRCAT6 ri0LD6N NAMm 7o TL�1L�T,HRRFAILWtE Tp•OU'sD91ULLL' , IMPOSE NO OBUGAnDN OR LIABILITY OF ANY IOND 046'•Til-INBI/R9*'RCSAOklila OR REPREBENTA AVIRIOR® A'RVE . . ACORD 25(2009101) 8j 1988-2009 ACORD CORPOIMTION.AVI rf"reserved. INS025 R2aoem) The ACORD name and logo are registered marks of ACORD 4. f ACQC4D. _ w4am aSi=;.yl'1�'l'1'•.187ldWuliPa ` TNIS.CERTFICATE III II*UEllA3 A.hLkTTW-ROFjNFORMArOW .� ONLY AND CONFERS NO RIGHTS UPON 4i1ETER1IFICATIE., '. H.J.Knight]ntematiDnal lnsuranccAgmcies,in[7. HOLDER. THES CERTIFICATE DOES NOT AMEND}•IL,7[TENO OR• ,, . 500 Victory Road-Marina any ALTER YnE COVERAGE AFFOR QED BY THE,POLKIES B�lOBf. North Quincy.MA 02I21 MPANIES A2"fCRI iCOVERAGE. COMtlPNY •�' A Atlantic Charles Insurance Company VbAC anw�a caMPANY plpjne Property Scrvicq Co.,InC. � COMPANY POSax 365 G ......_Topsfield,-MA:...01983.. .. ETOCENTif•r TNAY IngPOOC1Ea OF INSURANCE LNTEO BELOW WIVBBEEN 6811EOlOTNE PCYREO NAM[iD ABOVE FOItMEPOl1CY PfiWOD INDICATED.NOTWRNBTAMMOANY REQUIMMENT,TERM OR CONDITION OF ANY OONTRACTOROTMER DOCVMYNTEATH RE'EPECTTO WHICH TM CERIINCATEMAYBEISEUTDORMAYPERTAIN,TMEINBUAANCEAPiOROEDBYTHEPOGCIESDE=MBEDNFREWUSUW'C,;YwO LTHKTERMS,:- EAL1.ValOIW AxD CONDmONS OF SUCH POUCW.UMITB ENOWM WYMVC PEEN REDUCED BY PAID CtAVA& ' CD YYPEGPS,aU ." POUCTMIMN rOLICYBFECRYE POYGr Cp I noN 'WIiB•; LTR wTE PewonYl wTEplSotrrrt {A.TAe,oy� OSAmrALtWYITf BWaY INJURY OCt j COMPAENENaNE/pw OmLY UlIIALYAGfi i m%pv,OENTCONLMCWm PREWBF6:OPEBni10N6 PROPERIYOAW08OW T uxvDTCILDUNv PA9PSRTY OAtlVIOBAW t eJaTDegNacvcuoaENASAnv. . . mawmMea®OCt L PROOVCTaNMPIfiIED OPEA DIaPDCo,MPUJSgA66 t WHfflAt:i1TAL P6 MrBONALIN i _ . iROAPtlO1M IMWPFAI7 OANACE - Pfli60NILLINNAY AefONWla W9UlY •• RRgLYPNRT •• ,1NTAMO XVem.,„L. .W.ONMEDAVIOB IPma Pml DOOLY MIURY • , ALLOPd1®PVIOO (Paw<O•M loMnp.+R NWTDAVTOS PfmPERTP tMMAOE ' ..5I PONORNEDA eOOILYwmtreA . . ARRROKLLABAfIT '-66bY OALMOE • (DNRMFD'• a - ETCE1tSWBS1rY GLTf•OCOUIwvi�C VMBREUArmfil ACCREt'.ATE i OR,TA LIMN UROFELNPORM •'�{ A WCV00754903 II52010 InwoII erATBmRT iJlure — eAClvmDpa , t •t '500,000 aSIL,EE-PDLILYtvaR' •t. 500,000 cwwIe•e ci1EAN=TarEs•1 'SDD,000 otIRR OPauVnaNQFO TOFx 719, VEKM6MaANLIim ' _ ,aT SMONO PTJT OP lI R:ABOV E DESC W BED POLICIES ap DANCj:LI FD BBPpRB THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY Mt ENDEAVOR TO MAIL DAYSMTNfTENNOTIi:ETOYN6 CERTYICAYE HOLDER•t1ALtE0 TD]NEL£FT. BUT FAILURE TO MAIL SUCH NOTICE SNRLL PAPOS6 NOOSLIGASIDNOA LIABILITY OFANY FIND UPON THECONIPAMASAGEurioit jftATwIm ALMIW SDPSPNEStPiTATWE 1 � The Commonwealth of Massachusetts Department oflndustrial Accidents Ogee of Investigations 600 Washington Street " Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Lezibly Name (Business/Organizationandividuaq:� /t✓ (i�. �/i(�� ��[ _&/ - Address: Z�� o oi✓ i City/State/Zip: a lJz� AJ&a ,3 Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑Building addition [No workers' comp.insurance 5. We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.,R'Roof repairs insurance required.]t employees. (No workers' comp.insurance required.) 13.❑ Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner:who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ! I / !,/b•/f/� ��fYIY�Z J;4 rC�ui-,,-e� no W Policy#or Self-ins. Lic.M a✓OO TI-V�O 3 Expiration Date: /k— If If Job Site Address: s� L,6AVI I 1 City/State/Zip:Pzt/w Awl to I F J 8 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here y certi nder the pains penalties ofperjury that the information provided above is true and correct SiEM Phone " Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone #: cJO/t✓ i/I' /lrvll atim HIC#154326 Peter Vasilou Roofing • Siding • Painting EIN#56-2618812 505 Paradise Rd.—Unit 223 Job#: Swampscott,MA 01907 (978)666-0367 Job Location: 5 Leavitt Ct.—Salem,MA Dear Peter, July I,2010 The following estimate is for the roof installation for the property located at the above address.The following paragraphs describe the work that will be performed. GAF-Elk Corporation Weather Stopper System Plus Limited Warranty offers you a full coverage warranty on defective shingles—to be obtained directly from the manufacturer(see enclosed brochure). - Installation Procedure 4 Strip existing roof on the entire house down to the roof deck - +6 Install an 8 inch drip edge on all leading edges(rakes&fascia) 4. Install ice&water on all valleys 4l Install 6 feet of ice&water shield on all leading edges 1 Install full ice&water shield on small left rear low pitched section of roof A. Transitional walls are optional and incur an additional cost for the siding repair d. Install new vent pipe flanges 4. Replace any rotten or damaged decking(we allow 32SF a no charge,$70.00/sheet thereafter) 4 Replace any rotten or damaged ledger board(we allow 30ft.at no charge,$4.00/fl.thereafter) -& Install 15 pound felt paper on all areas that is not covered by ice&water shield d. Install new GAF 3-TAB shingles 4, Olympic will supply dump truck to remove debris & Homeowner to choose color of shingles COLOR:Additional Specifications 4, Our dumpsters are sent to a recycling facility;therefore no additional trash may be placed in them. The transfer station will charge us a fee for additional trash which will be passed on to the homeowner. J. Transition walls are an option,and if the existing flashing is in good shape,usually do not require replacement 4 During a roof job,it is not common for the nails to break the sheathing during the nailing of the shingles a We are not responsible for any of the cracks that may arise in any walls or ceilings J. Please cover all your floors in your attic to protect from dust and debris d. We will remove all of the job related debris ,.6 Permit costs vary from town to town and are not included in this bid Initial the options you are choosing below: Cost for Labor&Material for Roof: $3,995.00 Cost for 30-yr Architectural Upgrade: $ 280.00 Cost for Labor& Material to Re4ead&Re-flash Chimney: $ 495.00 Cost for GAF-Elk Weather Stopper System Plus Ltd.Warranty: $ 2.50.00 Payment Terms: 113 deposit$ Ko" t�0 113 work in progress$ e and 113 upon completion$ 30 ?d b� Total Amount Agreed To Be Paid: s q-7 40,oy Remit to: Alpine Property Services Company,Inc,P.O.Box 365, Topsfield,MA 01983 The following schedule will be adhered to unless circumstances beyond Alpine's control arise. - poll Lai zaLv Work Scheduled to Begin:_TBD_ r' "' 6� ��`d Expected Date of Completion: TBD Warranty: Alpine Property Services Company Inc.guarantees all work performed for a period of one year. If any problems occur we will cover the cost of all labor and material to correct the problem and meet the customer's satisfaction. Do not sign this contract if there are any blank spaces. (addin nal provisions follow and are incorporated 1 ein by this reference) s ael Conn ,Project anag asilou (pine Property Services Co ny Inc., omeowner d/b/a Olympic by(Name) Tel: (800)535-4312 Fax: (978)887-5875 • 239 Boston Street • Topsfield,NIA 01983 1-888-50LYMPIC • www.olymnicroofine.com